From the Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (DHF, BTJ, RW, LMD, WPD); Department of Family and Community Medicine, University of California-San Francisco, San Francisco, CA (DMH, LF).
J Am Board Fam Med. 2018 Nov-Dec;31(6):947-951. doi: 10.3122/jabfm.2018.06.180025.
Recruiting primary care practices for research projects has always required carefully tended relationships, a compelling message, and good timing. Recruiting practices to participate in practice transformation research trials may take more and different efforts. We reflect on practice recruitment for a recently-concluded trial of a diabetes self-management support system in 2 states and 36 practices.
Iterative qualitative analysis of field notes, semistructured clinician and staff interviews, and meeting notes from a 2-state, cluster-randomized trial that aimed to improve self-management support for patients with type 2 diabetes mellitus.
Although all 36 enrolled practices finished the study, fully recruiting practices early on took considerable effort, yielding 2 primary lessons: 1) practice-based research networks (PBRNs) must recruit more stakeholders at more levels, at the clinic, in the system, and across roles; and 2) practice recruitment is a process and may take longer than expected with unplanned turnover of key contacts. Adjusting our recruitment strategies required: helping with communication efforts in practices; aligning our study message according to stakeholders' interests; allowing for minor adaptations at the practice-level to align with critical practice workflows, staffing, and resources; re-engaging with clinical leadership over time; and identifying a "backup" champion due to turnover.
When undertaking a pragmatic clinical trial requiring substantial practice change in a PBRN setting across a large number of practices, it is important that PBRN leaders develop a comprehensive strategy to identify and engage a broad group of stakeholders within each practice, understand their needs and priorities around research, and design and implement a structured communications strategy to maintain engagement throughout every phase of the project.
招募初级保健实践参与研究项目一直需要精心维护的关系、有说服力的信息和良好的时机。招募实践参与实践转型研究试验可能需要更多不同的努力。我们回顾了最近在两个州的 36 个实践中进行的糖尿病自我管理支持系统研究试验的实践招募情况。
对来自两个州、采用集群随机试验设计的、旨在提高 2 型糖尿病患者自我管理支持的糖尿病自我管理支持系统的研究进行了迭代的定性分析，包括现场记录、半结构化临床医生和工作人员访谈以及会议记录。
尽管所有 36 个参与的实践都完成了研究，但早期充分招募实践需要付出相当大的努力，得出了两条主要经验教训：1）实践为基础的研究网络（PBRN）必须在更多层次、在诊所、在系统中以及在各个角色中招募更多的利益相关者；2）实践招募是一个过程，可能需要比预期更长的时间，并且关键联系人的离职是不可计划的。调整我们的招募策略需要：帮助实践进行沟通工作；根据利益相关者的利益调整我们的研究信息；允许在实践层面进行微小的调整，以符合关键实践工作流程、人员配置和资源；随着时间的推移重新与临床领导建立联系；并由于人员流动而确定“后备”拥护者。
当在一个大型实践网络中进行需要大量实践变革的实用临床试验时，PBRN 领导者必须制定一个全面的策略，以确定并吸引每个实践中的广泛利益相关者，了解他们对研究的需求和优先事项，并设计和实施一个结构化的沟通策略，以在项目的每个阶段保持参与。
